Delay from ACU to OR.........Versed

[staceyp413]

Looking for advice and the good ol' how do you do it?????

This is a 10 room suite OR. We have ACU prep our pts for surgery, however, many times they admit the pt and then move to the next one. In the mean time the Anesthesiologist and/or MD have been there, sometimes new orders made........specifically an order for versed.

The OR RN comes over, sees the order and then goes thru the chart ****there is no 'true handoff'******

My question is, what and how do you do it?

Do you see the same delays?

[canesdukegirl, BSN, RN]

I have the same question, and have often wondered about it. The pre-op holding nurses get the pts ready, then the anesthesia staff take the pt back to the OR. There is absolutely no communication between the pre-op and the OR nurses. This is the way all of the hospitals that I have worked in operate. My guess is that anesthesia takes over from pre-op and then gives report to PACU (although the OR staff is required to call PACU to give a brief report), and that is considered sufficient hand off. But the nurses are out of the loop. Doesn't make much sense...

[TammyCNOR]

We are dealing with the same type of issue, specifically on our record. There is a place to document that the surgical site is verified/marked. Many times this is not documented by the Pre-op staff because when they were finished getting the patient ready, the surgeon had not been in yet. When the surgeon does mark the surgical site, the Pre-op nurse has moved on to the next patient and does not come back to document. The Pre-op nurses argument is to have the OR nurses fill it in. Our DON feels this is important for the Pre-op nurses to be the 1st set of eyes/hands for correct site surgery and the OR nurses are the 2nd set of eyes to verify correct site. Any thoughts?

[Argo]

How we do things is pretty simple. I bring surgery patients to preop 30-60 minutes ahead of surgery start time. The preop nurse sees the patient and verifies consent/orders/H&P/ site verification. The surgeons see there patients and are required to sign the consent, H$P an orders. Anesthesia talks to te patient and the RN circulator must have seen the patient before they are allowed to roll to the room.

The key here is to have a manager that enforces these rules and jcaho regulations. I enforce them. As circulators you should stress to the manager that if they allow this to happen they can do the case themselves as you are seriously putting yourselves at risk of being part of a sentinel event.

[canesdukegirl, BSN, RN]

As always, Argo is right on target.

[brownbook]

What is (or who is) an ACU?

Every where I have worked anesthesia does not give versed until they have verified that the surgeon, OR, and pre-op nurse have talked to the patient. It just isn't done!!!!! They would get written up if they did it!

[staceyp413]

We do all the required elements and checks......just trying to better coordinate the Versed piece in the event the preop nurse moves on before anesthesia or the circulator arrive.........especially knowing all of the consents and verifications are done before it is given. Also finding it difficult to bring everyone together as we all try to stay on task.

ACU is ambulatory/short stay care. It is a staffed unit that preps surgicals and procedural patients.

Thank you Everyone!!

[PetiteOpRN]

In my hospital:

Preop/holding RN's: sign the patient in, get one set of vital signs.

CRNA: look over patient work-up, start IV/lines/blocks

Circulating RN's: take the patient to the bathroom, get a pregnancy test, if needed, verify consents, verify NPO status/current meds, have the patient change into a gown, verify mark, remove jewelry, dentures, false eyes, etc, send preop labs, get perioperative antibiotics, page the rest of the team to get their stuff done, get blankets so that the patient is comfortable on the way to the OR, transport patient to OR...

Since the holding nurses don't do any actual patient care, they have nothing to report to me. What a time-saver! Problem solved!